Welcome to Grant Warehouse

                                                                                                Addendum to Grant Readiness Form: Applicant Organization’s Information Collection Form

Addendum to Applicant Organization’s Information Collection Form: Purpose- This form will assist you with collecting information rarely requested by grant funders (e.g. list of all grants, with dollar amounts you’re your organization has ever been awarded; Resumes or Vitas for staff members to be assigned to the proposed project).
 
Legal Name of Organization:                                                    Is your organization operating as an AKA entity?  Yes ____ No _____
   If yes, what is the AKA name:
 
Corporate Office Street Address:

City:                                                                              State:                                             Zip:

Phone:                                                                           Website: 
 
Corporate Administrator’s Name: 

Tile: 

Phone:                                                                                  Email: 

Grant Contact Name:                                                             Title: 

Phone:                                                                                  Email: 

Signatory’s Name(s):                                                             Title: 

Phone:                                                                                  Email: 
 
 
What is the organization’s FEIN (Federal Employer ID Number): 

Is organization a 501 (c) (3)?  Yes _____ No _____  

 If yes, please upload a copy of the original IRS verification letter.

If no, indicate type of organization in accordance with IRS:

Non-profit without IRS status ______
Small business _______ 
For-profit business _____
Governmental Instrumentality _____
Municipality _____
School, College, University _____
Church or Religious Organization _____
 
 
Please Note: If the organization is not a 501(c) (3) nonprofit, and if allowed by grantor, a fiscal agent may be used. An MOU or another written agreement between organization and the fiscal agent must be completed, signed and uploaded.
 

 
Is the organization in Good Standing with the state?      

Yes ____ No ____ 

If yes, please attach the most current verification from your state.
 
 
 
 
 
 
 
 
 
What is the Organization’s Mission Statement:
 
 
 
What is the Organization’s Vision Statement:
 
 
 
 
How many members are on your organization’s Board of Directors? 

How frequently does the board meet? 

Please upload a list of names, board positions held, addresses, phone numbers, emails, and affiliations of each board member.
 
 
 
 
How many total people does the organization employ?

Of this total, how many are:
Full-time: ______
Part-time: _______
Contractual: _______
Volunteer: _______
 

What is the Organization’s Current Total Budget? 
 
 
Please include departments or satellite sites individual budgetary amounts, if applicable.
 
 
Describe each revenue stream, the funding source and yearly amounts.

Federal Funds:  

Name of Department:                                           

Length of Funding:
    Yearly Amount Received:                    If from grants, what is the project period?
 
State Funds:
     Name of Department:                                          
     Length of Funding:
     Yearly Amount Received:                       If from grants, what is the project period?
                       
State Funds, originating at the Federal level:
      Name of Department:                                          
       Length of Funding:
       Yearly Amount Received:                      If from grants, what is the project period?
           
Local Funding:
Name of Grantor: 
Name of Department:                                          
Length of Funding:
              Yearly Amount Received:         If from grants, what is the project period?
           
Private, Corporate and Public Foundations:
Name of Department:                                          
Length of Funding:
               Yearly Amount Received:         If from grants, what is the project period?
           
Fees, memberships, sales etc:
Name of Resource:                                          
Length of Funding:
Yearly Amount Received:                 If from grants, what is the project period?          
 
Other:  
Name of Department:                                          
Length of Funding:
Yearly Amount Received:                  If from grants, what is the project period?           
 
What population(s) does your organization serve?

Break down the list of total participants according to population sectors and indicate the total number of individuals served per year.

If the organization tracks number of service hours, visits, etc. please indicate.
 
 
 
 
 
 
 
What geographic area(s) does the organization cover.
 
 
 
 
 
 
 
 
 
Are there any requirements for individuals/families to be able to participate?  Please consider age, marital status, disability status, income limits, etc.
 
 
 
 
 
 
Upload a copy of the Organizational Chart.  Please include staff, administrators, contractors, volunteers and the board.